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Alabama set to move forward with Medicaid work requirements on Gov. Kay Ivey’s orders

Chip Brownlee

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By Chip Brownlee
Alabama Political Reporter

Alabama may become one of nearly a dozen mostly Republican states that are seeking a waiver from the federal government that could allow the state to institute work requirements for some of those who are on Medicaid.

Gov. Kay Ivey said Tuesday that she has directed Medicaid Commissioner Stefanie Azar to begin working on seeking a waiver for the requirements and raising co-pays for beneficiaries. States are typically required to request waivers from the federal government for changes to their Medicaid programs.

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“That process has been ongoing, and I look forward to the future implementation of those policies,” Ivey said.

The Trump administration last week issued guidelines for states wanting to test the requirement and has signaled that it would approve the waivers, a shift from previous policy that did not allow states to institute such a requirement.

Such a requirement, never before implemented in the 50-year history of the program, would force adult, able-bodied Medicaid beneficiaries to get a job or risk losing their coverage.

Eleven states, all but one of which has a Republican governor, have already submitted waivers. One state, Kentucky, has had their waiver approved, and another southern state, Louisiana, which has a Democratic governor, has said they make also seek a waiver. Alabama has not yet submitted a waiver request.

Though Medicaid wouldn’t need approval from the Legislature to move forward with implementing work requirements, Sen. Arthur Orr, R-Decatur, has proposed a bill that would require the agency to implement the requirements.

The program, if implemented, would likely allow the state to weigh factors like employment, skills training, job-searching and education when deciding which individuals can qualify for Medicaid.

Republicans say the measure would cost states money and would incentivize beneficiaries to get a job. Ivey said the move could be a cost-saving measure for Medicaid, Alabama’s biggest budget item.

“Improving Medicaid delivery and controlling costs is central to my budget; that is why I instructed Commissioner Stephanie Azar in October 2017, to begin working on implementing work requirements and increased copays for Medicaid recipients,” she said.

Ivey’s office did not offer specifics about changes to co-pays for those on Medicaid.

Her office said the move was aimed at increasing efficiency and decreasing costs “in an effort to be good stewards of taxpayer dollars.”

While the Medicaid agency requested much less in appropriations this year, it still eats up the largest portion of the state’s General Fund. Ivey’s proposed budget calls for the agency to receive $755 million in funding this year, up 7.7 percent from last year.

Orr’s bill outlines which individuals would be exempt from the requirement including those who under the age of 19, over the age of 65, medically unfit for employment, pregnant, the caretaker of a child under the age of 1. Individuals who care for a child with a serious medical condition or disability or those who are enrolled in a drug or alcohol rehab program would also be exempt.

Otherwise, able-bodied adults would be required to work or volunteer 20 hours per week, averaged monthly. Orr’s bill would also see the agency verify eligibility semi-annually instead of annually.

But it isn’t clear how many adults the move would actually affect.

Alabama has one of the lowest adult working-age Medicaid enrollments in the country with the majority of those on the program being children, pregnant women and low-income seniors. In November 2017, 52.3 percent of Medicaid beneficiaries were under the age of 18. Another 15 percent were low-income or disabled seniors over the age of 60.

State Sen. Trip Pittman, R-Montrose, chair of the Senate Finance and Taxation General Fund Committee, said he asked Ivey to seek the requirement. Pittman has long been a budget hawk who sought cost-saving measures in the Legislature, but he said Tuesday that he didn’t believe it would directly affect the budget initially.

“I don’t think it does that much in terms of initial value,” Pittman said. “But what it does do is it creates the dynamics of people going out and getting jobs or getting better jobs. America is about upper mobility, going out and pursuing opportunity.”

Pittman said there are some adults who could work or could get better jobs if only they were given some “incentive.”

“People can get very complacent, not everybody, but some people can get complacent so I think it’s always important for people to be encouraged,” Pittman said.

Democrats are largely opposed to the measure, which they believe would be burdensome for already low-income individuals.

“Folks are not on Medicaid because they want to be,” said Democratic Senate Minority Leader Billy Beasley, D-Clayton. “It’s a very small percentage of folks who are able-bodied.”

Most adults in the program are disabled, blind or the caretaker of a child in the program.

“If you have a disability, you can’t help it,” Beasley said. “Medicaid is to help people who have shortcomings of some kind, whether it’s a physical shortcoming or whatever it is. Medicaid does a real good job of screening folks who are eligible. I just don’t know that we would have very many people covered by Medicaid that could work.”

The Legislature would not have to move on the work requirements. If the federal government’s Department of Health and Human Services approves the waiver, the state Medicaid Agency will be able to move forward with implementing the requirement.

 

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House passes General Fund Budget

Brandon Moseley

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By Brandon Moseley
Alabama Political Reporter

The Alabama House of Representatives passed the state General Fund Budget on Tuesday.

The General Fund Budget for the 2019 fiscal year is Senate Bill 178. It is sponsored by Sen. Trip Pittman, R-Montrose. State Rep. Steve Clouse, R-Ozark, carried the budget on the House floor. Clouse chairs the House Ways and Means General Fund Committee.

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Clouse said, “Last year we monetized the BP settlement money and held over $97 million to this year.”

Clouse said that the state is still trying to come up with a solution to the federal lawsuit over the state prisons. The Governor’s Office has made some progress after she took over from Gov. Robert Bentley. The supplemental we just passed added $30 million to prisons.

The budget adds $50 million to the Department of Corrections.

Clouse said that the budget increased the money for prisons by $55,680,000 and includes $4.8 million to buy the privately-owned prison facility in Perry County.

Clouse said that the budget raises funding for the judicial system and raises the appropriation for the Forensic Sciences to $11.7 million.

The House passed a committee substitute so the Senate is either going to have to concur with the changes made by the House or a conference committee will have to be appointed. Clouse told reporters that he hoped that it did not have to go to conference.

Clouse said that the budget had added $860,000 to hire more Juvenile Probation Officers. After talking to officials with the court system that was cut in half in the amendment. The amendment also includes some wording the arbiters in the court lawsuit think we need.

The state General Fund Budget, SB178, passed 98-1.

Both budgets have now passed the Alabama House of Representatives.

The 2019 fiscal year begins on Oct. 1, 2018.

In addition to the SGF, the House also passed a supplemental appropriation for the current 2018 budget year. SB175 is also sponsored by Pittman and was carried by Clouse on the floor of the House.

SB175 includes $30 million in additional 2018 money for the Department of Corrections. The Departmental Emergency Fund, the Examiners of Public Accounts, the Insurance Department and Forensic Sciences received additional money.

Clouse said, “We knew dealing with the federal lawsuit was going to be expensive. We are adding $80 million to the Department of Corrections.”

State Representative Johnny Mack Morrow, R-Red Bay, said that state Department of Forensics was cut from $14 million to $9 million. “Why are we adding money for DA and courts if we don’t have money for forensics to provide evidence? if there is any agency in law enforcement or the court system that should be funded it is Forensics.”

The supplemental 2018 appropriation passed 80 to 1.

The House also passed SB203. It was sponsored by Pittman and was carried in the House by State Rep. Ken Johnson, R-Moulton. It raises securities and registration fees for agents and investment advisors. It increases the filing fees for certain management investment companies. Johnson said that those fees had not been adjusted since 2009.

The House also passed SB176, which is an annual appropriation for the Coalition Against Domestic Violence. The bill requires that the agency have an operations plan, audited financial statement, and quarterly and end of year reports. SB176 is sponsored by Pittman and was carried on the House floor by State Rep. Elaine Beech, D-Chatham.

The House passed Senate Bill 185 which gives state employees a cost of living increase in the 2019 budget beginning on October 1. It was sponsored by Sen. Clyde Chambliss, R-Prattville and was being carried on the House floor by state Rep. Dimitri Polizos, R-Montgomery.

Polizos said that this was the first raise for non-education state employees in nine years. It is a 3 percent raise.

SB185 passed 101-0.

Senate Bill 215 gives retired state employees a one time bonus check. SB215 is sponsored by Senator Gerald Dial, R-Lineville, and was carried on the House floor by state Rep. Kerry Rich, R-Guntersville.

Rich said that retired employees will get a bonus $1  for every month that they worked for the state. For employees who retired with 25 years of service that will be a $300 one time bonus. A 20-year retiree would get $240 and a 35-year employee would get $420.

SB215 passed the House 87-0.

The House passed Senate Bill 231, which is the appropriation bill increase amount to the Emergency Forest Fire and Insect and Disease Fund. SB231 is sponsored by Sen. Steve Livingston, R-Scottsboro, and was carried on the House floor by state Rep. Kyle South, R-Fayette.

State Rep. Elaine Beech, D-Chathom, said, “Thank you for bringing this bill my district is full of trees and you never know when a forest fire will hit.

SB231 passed 87-2.

The state of Alabama is unique among the states in that most of the money is earmarked for specific purposes allowing the Legislature little year-to-year flexibility in moving funds around.

The SGF includes appropriations for the Alabama Medicaid Agency, the courts, the Alabama Law Enforcement Agency, the Alabama Department of Corrections, mental health, and most state agencies that are no education related. The Alabama Department of Transportation gets their funding mostly from state fuel taxes.

The Legislature also gives ALEA a portion of the gas taxes. K-12 education, the two year college system, and all the universities get their state support from the education trust fund (ETF) budget. There are also billions of dollars in revenue that are earmarked for a variety of purposes that does not show up in the SGF or ETF budgets.

Examples of that include the Public Service Commission, which collects utility taxes from the industries that it regulates. The PSC is supported entirely by its own revenue streams and contributes $13 million to the SGF. The Secretary of State’s Office is entirely funded by its corporate filing and other fees and gets no SGF appropriation.

Clouse warned reporters that part of the reason this budget had so much money was due to the BP oil spill settlement that provided money for the 2018 budget and $97 million for the 2019 budget. Clouse said they elected to make a $13 million repayment to the Alabama Trust fund that was not due until 2020 but that is all that was held over for 2020.

Clouse predicted that the Legislature will have to make some hard decisions about revenue in next year’s session.

 

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Day Care bill delayed for second time on Senate floor, may be back Thursday

Sam Mattison

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By Samuel Mattison
Alabama Political Reporter

The day care bill, which would license certain day care centers in Alabama, was once again delayed on the state Senate floor after one lawmaker requested more information.

Its brief appearance Tuesday ended with state Sen. Gerald Dial, R-Lineville, saying a compromise had not yet been worked out with the bill’s detractors.

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Alabama’s Senate has been hesitant to act on the legislation because of complaints of state Sen. Shay Shelnutt, R-Trussville, who has been an opponent of the bill since its introduction last year. The bill’s delay on Tuesday marks the second time its been taken off the Senate’s agenda.

The bill has had a rocky time in this year’s session, but the bill’s sponsor state Rep. Pebblin Warren, D-Tuskegee, said she is still confident about its passage out of the Legislature.

Warren, D-Tuskegee, filed the bill this session with the support of influential lawmakers including Gov. Kay Ivey, who told reporters last year that she though all day cares should be licensed.

Mainly sparked by the death of 5-year-old boy in the care of a unlicensed day care worker, the bill had great momentum coming into this year’ session.

Despite the growing support from lawmakers, Religious groups had concerns that the bill would increase state-sponsored reach into religious day cares in churches and non-profit groups.

Spearheading the dissenters was Alabama Citizens Action Program, a conservative religious-based PAC.

Warren, proponents, and ALCAP announced a compromise to the bill while it was still in the Alabama House.

Announced by ALCAP originally, the new bill was a weaker version in that it did not require that all day cares in the state be regulated. Instead, religious-based day cares would only need to be registered if they received federal funds. At a Senate committee meeting in February, Warren said a similar requirement was about to come from federal law in Congress.

The bill moved through the House in a overwhelming vote in favor of the proposal and passed unanimously out of a Senate committee a few weeks ago.

Warren, speaking to reporters after its passage from the House, said she was unsure if the bill would encounter resistance in the upper chamber.

It was the Senate that killed the daycare bill last year amid a cramped last day where senators took the bill off the floor. The bill may face similar complications this year, as lawmakers seem to be preparing to adjourn within a few weeks.

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Fantasy sports bill fails on Senate floor

Sam Mattison

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By Samuel Mattison
Alabama Political Reporter

Would-be Fantasy Sports players in Alabama will have to wait to legally play in the state following a Senate vote on Tuesday.

The Alabama Senate decisively killed a bill to exempt fantasy sports from the state’s prohibition on gambling.

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Not even entertaining a debate on the Senate floor, the proposal was killed during a vote for the Budget Isolation Resolution, which is usually a formality vote preluding a debate.

Fantasy sports are contests where participants select players from real teams to compete on fantasy teams using the real-world players’ stats.

Since 2016, the practice has been illegal in Alabama following a legal decision by the Attorney General’s Office that categorized it as gambling.

The bill’s sponsor, state Sen. Paul Sanford, R-Huntsville, predicted the bill’s failure during a committee meeting two weeks ago, where the bill passed unanimously.

Sen. Paul Sanford speaks to reporters after a Senate Committee meeting on Feb. 28, 2018. (Samuel Mattison/APR)

Speaking to reporter’s after the committee meeting, Sanford said the decision to file the bill was mainly a philosophical belief that the practice shouldn’t be illegal.

Sanford, a fantasy sports player before its ban, said that fantasy sports are a way to bring people closer together and not a means to win money. The Huntsville senator is not seeking re-election.

The bill’s failure in the Senate follows its trajectory last year too. A similar version of the bill, also sponsored by Sanford, failed in the Senate during the final days of the 2017 Legislative Session.

Since Sanford is retiring, it is unclear if the bill will even come back next session, or if it will even have a Senate sponsor.

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Alabama set to move forward with Medicaid work requirements on Gov. Kay Ivey’s orders

by Chip Brownlee Read Time: 4 min
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